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CAPA Treatment — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsCAPA TreatmentSCE Infectious Diseases

A 50-year-old man with severe COVID-19 pneumonia on the ICU develops secondary invasive aspergillosis (COVID-associated pulmonary aspergillosis — CAPA). Tracheal aspirate culture grows Aspergillus fumigatus. Serum galactomannan is positive. What is the first-line treatment?

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Correct answer: A — Voriconazole IV (or Isavuconazole)

COVID-associated pulmonary aspergillosis (CAPA) is a recognised complication of severe COVID-19, particularly in ICU patients on corticosteroids (Dexamethasone — part of standard COVID-19 treatment) and those receiving tocilizumab. Treatment follows standard invasive aspergillosis guidelines: Voriconazole (first-line) or Isavuconazole, with TDM. Liposomal Amphotericin B is an alternative. Distinguishing CAPA from Aspergillus colonisation requires a high index of suspicion plus galactomannan/culture positivity plus compatible clinical/radiological features.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections